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Article History

Received: 19 November 2025

Accepted: 22 January 2026

First Online: 28 January 2026

Declarations

:

: The study protocol, including the consent procedure (informed consent waiver), was approved by the Ethics Review Board of Hyogo Medical University on June 24, 2025, with approval number 5058, and conducted in accordance with the principles of the Declaration of Helsinki. Although participants in the present study did not provide written or verbal informed consent, they were allowed to refuse or withdraw from participation at any time. This opt-out procedure conforms to the Japanese Ethical Guidelines for Epidemiological Research for observational studies that use existing data.

: Not applicable.

: The authors declare no competing interests.